Lipo3000 br Declarations of interest br None br
Declarations of interest
This work was supported by a Breast Cancer Research Foundation Grant
# 20150695 and by the Cousins Center for Psychoneuroimmunology. CCB was supported as a postdoctoral fellow at the Cousins Center for Psychoneuroimmunology.
Appendix A. Supplementary data
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Changes in insurance coverage for cancer patients receiving brachytherapy before and after enactment of the Affordable Care Act
Daphna Y. Spiegel1, Fumiko Chino1, Haley Moss2, Laura J. Havrilesky2, Junzo P. Chino1,* 1Department of Radiation Oncology, Duke University Medical Center, Durham, NC 2Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC
ABSTRACT PURPOSE: The Patient Protection and Affordable Care Act called for expansion of Medicaid in
2014. As some states elected to expand Medicaid and others did not, the goal of this study was to
determine the effect of Medicaid expansion on the insurance status at cancer diagnosis of brachy-
METHODS AND MATERIALS: Patients aged 19e64 years with breast, cervical, uterine, or
prostate cancer treated with brachytherapy from 2011 to 2014 with known insurance status were
identified within the Surveillance, Epidemiology, and End Results registry. Fisher’s exact test
was used to test for associations of insurance status with expanded versus nonexpanded states.
For multivariate analysis, a binomial logistic regression was performed, dichotomized to uninsured
versus any insurance.
RESULTS: Fifteen thousand four hundred ninety-seven subjects met entry criteria. In the entire
cohort, rates of uninsurance were higher in nonexpanded states at baseline (4.5% vs. 2.9%, p !
0.00001). With selective Medicaid expansion in 2014, expanded states had a Lipo3000 in uninsur-
CONCLUSIONS: Patients who received brachytherapy were less likely to be uninsured in states
where Medicaid was expanded, particularly evident in regions with highest poverty levels. These
results should help inform policy decisions and efforts to ensure that all patients have access to high
quality treatments, such as brachytherapy. 2018 American Brachytherapy Society. Published by
Elsevier Inc. All rights reserved. Keywords: Affordable Care Act; Brachytherapy; Cervical cancer; Endometrial cancer; Prostate cancer
The federal Patient Protection and Affordable Care Act (ACA), more commonly known as the ACA was signed on
Financial disclosure: LJH reports research funding pending from As-traZeneca outside the submitted work. JPC has ownership in NanoScint, Inc and research funding from Varian Medical Systems outside the submit-ted work. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflict of interest: The remainder of the authors report no proprietary or commercial interest in any product mentioned or concept discussed in fossil record article.
* Corresponding author. Department of Radiation Oncology, Duke
E-mail address: [email protected] (J.P. Chino).
March 23, 2010. The purpose of this comprehensive health care reform was to expand access to insurance, control health care costs, and improve health care delivery. Key provisions to help expand insurance access included requiring em-ployers to cover their workers or pay penalties, provide tax credits to certain small businesses that covered costs of health insurance for their employees, provide federal sub-sidies to help those afford health insurance premiums, and expand Medicaid to cover people with incomes below 138% of the federal poverty limit guidelines (1).
While the expansion of Medicaid was intended to be national, a June 2012 Supreme Court ruling gave states the option to implement certain new health insurance re-quirements, including the expansion of their Medicaid pro-grams under the ACA (2). Almost half of the U.S. states elected not to expand Medicaid at the beginning of 2014, including most of the Southeast and Plains states.
1538-4721/$ - see front matter 2018 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
Presently, 33 states (including the District of Columbia) have adopted Medicaid expansions and four states are considering expansion (ID, UT, NE, and VA). Fourteen states have not adopted Medicaid expansions (3). Expan-sion of Medicaid has allowed millions of Americans to gain health care coverage under the ACA, but state deci-sions not to expand Medicaid leave many without an affordable coverage option.